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January 4, 2013

Orange groves and beyond

Box Springs Mountain, with its peak at 3,047 feet, towers over eastern Riverside to form the border between it and western Moreno Valley, another Inland Empire city.
Box Springs Mountain, with its peak at 3,047 feet, towers over eastern Riverside to form the border between it and western Moreno Valley, another Inland Empire city.

You could say Riverside’s march to prosperity started with Mrs. Eliza Tibbets. In the early 1870s she planted two navel orange trees sent from the U.S. Department of Agriculture.

Citrus growing wasn’t new to California’s Inland Empire, now made up of San Bernardino and Riverside Counties, 50 miles west of Los Angeles. Missionaries planted oranges around 1800, and lemon growers helped stave off scurvy among Gold Rush prospectors. But Mrs. Tibbets’ trees were special - Brazilian Bahia navels - with the sweetest flavor around and, another plus, no seeds.

The orange trees loved the climate and soil, and soon more and more

Some 1,900 trees (more than 23 varieties) line the seven mile stretch of Victoria Avenue, which is on the National Register of Historic Places.
Some 1,900 trees (more than 23 varieties) line the seven mile stretch of Victoria Avenue, which is on the National Register of Historic Places.

people were loving their fruit. Groves spread throughout the region, and California’s Second Gold Rush was off and running.

The juicy crop went national when rail service arrived, and the first commercial refrigerated freight shipment proceeded to points near and far in 1887. California citrus groves multiplied from 3,000 to 40,000 acres. In 1893, growers organized a co-op that would become Sunkist Growers, Inc. Riverside became known as the Citrus Capital of the World.

The original 1917 structure of the UC Citrus Experiment Station now houses the UC A.
The original 1917 structure of the UC Citrus Experiment Station now houses the UC A.

A citrus research station established at the time eventually morphed into today’s University of California Riverside. A century later, in 2012, UCR will accommodate one of the area’s newest needs when it opens the region’s first new public medical school in more than four decades. Until now, students have enrolled in a two-year program, completing work at UCLA.

Meanwhile, population has overcome most of the old agriculture.  Riverside groves have segued into subdivisions, and the industry has mostly moved elsewhere. But Kathryn Hayes, MD, and her family found at least one vestige. "We live in orange groves, a couple of miles south of the freeway," she happily reports. "I wanted a house with mature trees, and I’ve got 140 orange trees, plus several other full-grown trees around the house." And Hayes, an OB/GYN associated with Kaiser Permanente Riverside Medical Center, can’t help gloating, "We have the best oranges in the world!"

Another holdout is the California Citrus State Historic Park on the southwest edge of the city. About half of this 377-acre government protectorate is still cultivated commercially by a non-profit corporation. Also blooming in an exhibition area are 75 varieties of citrus. Thanks to the old orange industry, Riverside was once hailed as the wealthiest per capita American city. Its high rollers created a legacy of historic charm that still mesmerizes residents like Hayes, a Maryland native, although, at first, the city wasn’t her idea of the perfect place to live. "I married a Californian, and he didn’t ever want to leave," she explains. He finished doctoral studies at La Sierra University, one of the city’s four colleges and universities, then became a biology professor there. Their orange grove home is "close to family, close to church, my kids’ church school and cultural things that I enjoy."

For her, it’s a commuting-haters dream, "only five miles to my job." A longer ride doesn’t seem to be a problem for many physicians practicing in Riverside, though. "Probably in my department, more than 50 percent are commuting from somewhere else," she says.

As for her, "I like our little downtown. There’s a tiny mall with some interesting shops and a [farmers’] market on Wednesday nights. She’s also charmed by "historic neighborhoods that are really pretty, especially a wonderful area near Riverside Community College (RCC) that has bungalows with a California personality."

Among other serendipities: "There’s a good little symphony at the Municipal Auditorium. There are good cultural things at UCR and RCC - plenty of things to do if you don’t want to leave town, but we do go to the Hollywood Bowl [in Los Angeles] once or twice a year, and my husband takes our son (age 11) to see Anaheim Angels baseball games several times a season."

Rough economic waters

Things could change in the near future for some of the commuting colleagues, thanks to current hard-to-believe home prices. California has taken one of the biggest hits in the current home foreclosure debacle, and the Inland Empire has suffered more than any other region except for Stockton, 80 miles east of San Francisco.

According to John Husing, an economist and long-time authority on the Riverside statsInland Empire, mortgage defaults hit a record 26,171. "We’re going through the bottom right now," he says, "but housing sales have started to rise, which is an important indicator. Prices are exactly where they were in 2004 before speculators drove the market wacko. Once the demand for new homes picks up, developers will have to quickly go back into the construction business."

Layoffs or not, Southern California, according to a recent newspaper report, has been the state’s job creation leader for more than ten years, and, with many acres of undeveloped land, still has space for an expected 2 million newcomers by 2020.

The good news for now is a price disparity of as much as $250,000 between Riverside area communities and such "coastal" locations as Orange County, Los Angeles and San Diego.  As Husing wrote in a July quarterly report, "Even though home prices have fallen throughout Southern California, the Inland Empire has retained its role as the major alternative for homebuyers seeking affordable houses." Since May, 2007, the highest paying employment sectors have added some 2,900 jobs, more than 4,000 in education, 1,900 in government and 3,200 in health care to catch up with earlier population growth.

Not only that, Husing probably has good news for other physicians in search of jobs. Historically, he says, when the orange industry moved on, others came to fill in the gap, with the pattern repeating itself over the years.

"What happens in our business community is you have people taking risks to start businesses. They start here, and they grow here. When companies start getting bigger, the entrepreneurs start leaving. But at the same time a bunch of other people start a bunch of other companies. That’s why you see, time after time, a wave of innovation coming out of this area that has changed the direction of the economy."

Increasing development

Today’s Inland Empire lineup includes some 50 high tech companies, among them medical software firms, generic drug development, medical device manufacturing, and electronic gaming systems. Aerospace and aftermarket auto parts businesses still flourish, and so does filmmaking. In fact, some filmmakers call it "Hollywood’s Largest Back Lot" because of its many and varied location sites. In one place or another, there are "New England towns," "Midwest farms," "French vineyards," "Middle Eastern sand dunes," and many others.

In real-life Riverside, there also seems to be something for everyone. Hayes’ perfect setting is not the nirvana of family practitioner Carl Knopke, but the city fits his specifications because it’s "reinventing itself." An MD associated with Riverside Community Hospital, he says, "I like the way [the city] has been developing new shopping centers and restaurants, including a handful of fine dining establishments." With 48 cities in the two counties, there’s a good choice of these in nearby locations, too. Growing up in Sacramento, Knopke says he was spoiled by his family’s proximity to San Francisco and its cultural attractions, not to be equaled, in his opinion, by Riverside’s performing arts offerings, but the growing number of movie theaters is a plus.

Built between 1902 and 1932, and now considered to be Riverside’s
Built between 1902 and 1932, and now considered to be Riverside’s "symbol," the Mission Inn is a masterpiece mixture of Mission and Spanish Revival, Moorish, and Asian architectural styles.

He did find his professional niche, though, after finishing a residency at Riverside County Regional Medical Center in nearby Moreno Valley. He learned of Raincross Medical Group, a clinic in the same zip code that was looking for new doctors, found a simpatico ambience and signed on. (A "raincross," designed by an artist associated with the Mission Inn, was later adopted as the city’s signature symbol. It’s a combination of a mission bell and a Native American rain symbol.)

The clinic, Knopke says, is the next best thing to a solo practice, with most of the "infrastructure" in place. Among other things, "They simply added my name to the insurance policy and added another phone line." He furnished his niche mostly from a collection of extra equipment, including two examining tables, donated by his new colleagues. As he quips, "My startup cost was $1,200, basically cotton balls and Q-tips."

You could say Richard Rajaratnam, MD, has followed the long line of previous California entrepreneurs. His lengthy odyssey to "a land of opportunity" started in Sri Lanka, with some years in London to train as a surgeon (and become a fellow of the Royal College of Surgeons), and then for residencies, in Baltimore, and at Loma Linda University Medical Center about eight miles from Riverside.

By a happy coincidence, in 1989 Kaiser Permanente in Riverside was seeking physicians for its new department of head and neck surgery, his specialty. (Today, Rajaratnam is also K-P’s area medical director.) "I chose it," he explains, "because I thought this was an opportunity to come into a new facility, a program that was being commenced newly and one that would give me the opportunity to improve the health of people in a kind of bedroom community which had a lot of history behind it." Furthermore, "I thought I could make some contributions beginning in that type of environment. I had the opportunity to expand the program as well." He was right. K-P, with an already large presence in Southern California, continues to increase its service, currently with a new hospital in nearby Moreno Valley and new medical office buildings in two other cities.

The Loma Linda medical complex, one of 61 U.S.-based Seventh-day Adventist institutions, is also expanding. Michael Rauser, MD, reports that his Loma Linda University ophthalmology department is planning a full-service clinic in Riverside in addition to its main facility at the university’s hospital. "I don’t think we have a lot of patients in the Riverside area who come to our main site, so we need to get an office closer to them," he says. "I think there’s a huge need out there. That will also give Riverside patients an opportunity to participate in various studies and clinical trials."

The Loma Linda "mother" hospital houses the sole Level One trauma center between there and Las Vegas (225 miles), but, according to physician recruiter Roy Wu, it’s known best for it children’s care facilities, "a very large NICU" and was the site of the very first human-to-human baby heart transplant, performed by Leonard Bailey, MD, in 1985. LLU’s most recent innovation is proton therapy, a precise form of radiation treatment for cancer and other conditions. The center recently treated its 12,000th patient.

At least one department is truly unique in the world, thanks to Sean Bush, MD, a self-confessed snake and dangerous animal addict. His infatuation inspired him to start a venomology department. He treats local victims of snake, spider and poisonous insect bites, but also conducts a large educational program.

New ideas, traditional charm

The city of Riverside itself offers pleasant surprises, surging into the future without sacrificing its traditional charm, appealing to such diverse "appetites" as those of Hayes, Knopke and Rajaratnam. (Rauser’s major leisure pursuit is going to the beach with his wife and two children. For five years he endured Midwest snow and cold, so he likes "the ability to wake up every day and not worry about the weather. We never even turn on the weather channel here. We know it’s going to be sunny and warm."

On a day-to-day basis, Rajaratnam praises Riverside because "this is a community where everybody looks for the common interest and works together for the success of the city. I like the camaraderie between local agencies trying to improve the city as a whole." Besides that, the schools "are an example of residents working together. When parents are involved, the teachers are on their toes."

The caring-about-others incentive extends to area ethnic groups, especially Hispanics. Although doctors and hospitals contract with interpreter services, it doesn’t take long for word of mouth to spread if one Hispanic patient finds a Spanish-speaking physician.

Even in a "downturn" time, city leaders have found ways to accomplish the "impossible." In 2006, the City Council approved a $1.8 billion infrastructure and capital improvement plan titled Riverside Renaissance. The aim, say coordinators, is "to do 20 years’ worth of public works projects in five years." The list of 183 improvement schemes is mind boggling - from public utilities replacements to new parks and libraries, Hispanic youth center, three fire stations, a fitness center, youth opportunity center, aquatic facility, and an historic theater refitted as a performing arts center.

The city is also collecting awards from the state for its all-out assault on environmental foes, including air pollution, water squandering, and overuse of power. "We want to become the solar city in California," boasts Mike Bacich, spokesman and sustainability officer for the city-owned Riverside Public Utilities.

He lists 38 successful conservation "action items" initiated by the Green Task Force, such as free and subsidized new residential trees, plus rebates for various energy-efficient living strategies. The city has even installed a system to convert restaurant grease into electricity.

In spite of the blitzkrieg toward the future, a comforting factor for Rajaratnam is that Riverside still prizes its strong neighborly atmosphere, including his congenial work environment. Kaiser Permanente, he says, is "very collegial and collaborative."

KP’s concern for patients dates back to the Great Depression, when Sidney Garfield, MD, established a 12-bed hospital in the citrus capital to care for the thousands of workers on the massive Los Angeles Aqueduct. From this beginning, a mighty national network developed. As a major presence in Southern California, KP has adopted or created many innovative procedures and is now a strong cheerleader for patient wellness. Among other achievements: More than 94 percent of the over-55 female population has been screened for breast cancer, the nation’s best rate.

Chronic disease management goes hand in hand with the wellness concept. Among other efforts, Rajaratnam reports, "We use cellular phones to manage these diseases on a fairly real time basis. We are in constant communication with badly diabetic patients, either by text messaging or possibly phone. We put into their cell phones their blood sugar levels, type of diet, and exercise program we have agreed upon. Monitors track them and sometimes phone to make sure they’re following the regimen," he explains. "Our patients love it. It’s very successful in reducing their complications. And everybody wins."

A striking new, nine-story building will cap a five-year expansion program for Riverside Community Hospital, but, in the meantime, RCH has become known, among other things, as the area’s first designated receiving center for STEMI patients (ST-Elevation Myocardial Infarction) and for its new blood management program which emphasizes alternatives to transfusions. It will soon offer minimally invasive surgery using the county’s first da Vinci robot.

Parkview Community Hospital Medical Center, opened in 1958, also has a large Riverside presence, with 193 beds and some 350 physicians. Its maternity program has received a five-star rating from HealthGrades and includes a Level Three NICU, with a ready transport team. Among its other centers of excellence is a certified bariatric surgery program complete with such features as wider doors and toilet seats in specially designed rooms. Opening this month, a redesigned Orthopedic Solutions area almost mimics a spa resort, complete with on-site physical therapy, daily social hours, a putting green, and patient education sessions.

As spokeswoman Marlene Burnett puts it, "We have the latest technology and equipment while continuing to focus on the most important part of healing - the human touch."
It seems these professional opportunities match Riverside’s lifestyle opportunities - both offer the chance to feel good where you are.

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